The Vine: February 20, 2013

If your new boyfriend tells you he's taking an acne medication but you suspect for various reasons that it's an antidepressant, but you don't push it because you've only known each other a few weeks and you actually feel like it's classy of him to create this polite fiction for both of you, and six months later he's maintained the acne-medication party line while being scrupulously open and honest about everything else to the point where you begin to believe him, then one day he leaves the bottle lying around and you find that it is in fact an antidepressant, is there a gentle and reassuring way to say, "Hey, it's cool, I know and I don't care, you don't need to lie anymore," or should you just go along with the non-truth because he seems to still need it, or should you assume that his carelessness with the evidence was the confession, or should you be concerned that you'll undermine your own "I don't care" message if you admit to picking up the bottle and turning it around and carefully typing the long word on it into Wikipedia? Hypothetically.

Just Nosy Not Judgmental

Dear Just,

First, way to get pretty nearly your entire letter into a single sentence. I do believe this is a Vine first.

Second, I would assume that his leaving the bottle around is, if not "the confession," then an indication that he unconsciously trusts you to know and not care.

And that's what he wants, obviously, but at first he said something different, and the more time that goes by, the more awkward it is to reveal that it's actually an antidepressant, and the more it seems like a Big Secret instead of a little-ish thing he fibbed about because he don't know at that point how much he wanted to share of himself and his problems.

I wouldn't admit to Googling the medication; I wouldn't say anything at all, since you, you know, don't care. But if a few more months go by and he still hasn't said anything, maybe it's time to bring it up. If it's a medication or a dosage that indicates a more serious problem, it's definitely time to bring it up — if it's a medication more often associated with treatment of seizure disorder, for instance. Then it's a safety issue, and six months in, that's the kind of thing you need to know.

But I'd give it a few months more and leave the door open for him to tell you. If he does, you can decide if you want to admit to looking it up; if he doesn't, it's probably time to rip the Band-Aid off yourself.

23 Comments »

I'll add a couple of other points: Because there's so much guesswork in developing antidepressants, a lot of them end up having official and/or off-label uses for other ailments. For example, I take a small dose of an older antidepressant as a sleep aid. Almost no one uses it as an antidepressant because (a) it's a crappy antidepressant, and (b) it has a very powerful sleep side effect, one much more potent than its intended "real" effect. I haven't heard of any that have been repurposed as acne medication, but I wouldn't be surprised, either.

My second point would be to be as clear about your non-judginess as possible if you do end up bringing the issue up yourself, assuming that he was initially fibbing about it being for acne instead of depression. I take antidepressants for a mood disorder, and as I've gotten older, I've become very, very careful about how, if ever, I reveal that fact to acquaintances, coworkers, and even friends. It's a scary place to be, because there is a lot of judginess out there about it, and after you've had one too many unpleasant conversations about it, you start to avoid the situation completely. It's not so much because you want to keep crummy friends, but it's just easier to get through life without it being A BIG DEAL with everyone you know. It's even more fraught in a dating-type situation. (Personally, I've pretty much given up on dating altogether because of it, but that would be my own sad little Vine letter.)

Personally, I'd feel relieved if you brought it up in conversation with a strong preface of "I'm not freaking out about this and I don't see it as a character flaw–I just want to know/understand because I care," but I wouldn't absolutely recommend that, since we're all different.

I would use the X Files test for when to tell him. As in "Am I starting to feel like Scully from around season 3?" You can only maintain the skepticism in the face of alien abduction, lighting rod teenage Giovanni Ribisi, and Fluke Boy for so long. After that point your inner audience will start muttering "C'mon already!"

What JC said. Lots of drugs treat multiple symptoms or have positive side effects, and some doctors will play pretty fast and loose with the off-label use. A certain antidepressant didn't do shit for my mood… but it did stop my chronic nail fungus, go figure. It's not an "antifungal drug", but it worked better than any other antifungal product I've used, and that's the only reason I kept taking it.

I don't know anything about acne medication, but when my doctor was trying to find a medication for my migraines, I tried a beta blocker (no help), a medicine that I'm pretty sure was on the list that MJ was taking at the time of his death (made me sick), and then an anti-depressant (made me sick) in a long line of prescriptions. So though it was technically an anti-depressant, to me, it was migraine medicine.

I'm not saying your boyfriend isn't withholding information about his depression, but it might also be that his acne medication is technically an anti-depressant, but he doesn't think of it in that way because that's the condition is he is taking it for.

A thought: if and when you approach him, you might not want to do so all, "It's OK, I know this is really anti-depressant medication" because if he IS taking it for its off-label use of fighting acne, he'll likely be hurt by your assumption that he's lying, particularly in light of a history of being "scrupulously open and honest."

It may be better to come at it more like, "A coworker told me that she takes Shmenlerzepton — that's your stuff, right? But she takes it for depression" and see what he offers up.

I also take a medication to reduce migraines that is primarily prescribed for blood pressure. However, this was all explained by my doc, so if someone noted that, hey, their dad has high BP too, I would know enough to understand and correct their interpretation. Of course, migraine does not carry the same stigma as depression.

If he's taking other medication that actually is for acne, there's a good chance that the antidepressant is part of that regimen. Certain acne drugs (Accutane is the big one) can have serious psychiatric side effects. Before my dermatologist would prescribe Accutane, I had to agree to see a therapist for the duration of my time on it. And because I had dealt with depression years earlier, that therapist subsequently recommended a mild dose of an antidepressant to take alongside the anti-acne drug. It was a bit uncomfortable to talk about – I actually had a friend say "But I thought you were all better!" – so I just stopped mentioning it by name and said it was part of my skin regimen. It's possible that your boyfriend is doing the same thing.

Sars, you hit on an important point: many drugs now prescribed for antidepressant use have long been prescribed for seizure disorders (and still are). And not all seizures are the falling on the floor and shaking type – some are so subtle they can be very hard to notice for weeks or months on end, like the absent seizures my daughter has. Just something to think about.

Curiosity overcame me, and I did a little searching. Turns out some antidepressants have side effects that help with dermatological problems. I found it in an abstract on pubmed, so I couldn't see the article, but it talked not only about using antidepressants to treat people upset about dermatological conditions, but also how some antidepressants have dermatological benefits as side effects. Strange but true.

In my own experience, I've also found that many doctors have their own, non-documented off-label uses antidepressant medications, which further complicates the issue. The caveat, of course, is that I'm not a pharmacologist–I've just been on a ton of psychopharm meds and, due to several geographic moves, have had the fortune/misfortune of seeing a lot of different doctors with their own idiosyncratic takes on their use.

It may be better to come at it more like, "A coworker told me that she takes Shmenlerzepton — that's your stuff, right? But she takes it for depression" and see what he offers up.

Though I give you props for your made-up psych drug name (funny), I would not do this. It's a bit disingenuous, plus it gives undue importance to this issue. Maybe he takes an antidepressant for its labeled purpose–well, a lot of people do. I do. Several of my friends do. Maybe he's still weirded out by it, but he can learn not to be ashamed of it if you treat it as the non-issue that it is.

On the generic topic of Bringing Things Up and privacy fibs, I had long held a sneaking suspicion that the boyfriend's ex was actually my BFF (I'd met them both at the same time.) I realized this on my own, came to terms with it and figured he would let me know when he was ready.

Another friend outed him though, with a "When you and X were still together…" He was more than relieved (and more than a little surprised) when I told him I'd figured that out long ago and it's cool.

Your sitch is a little different, since he might have a medical condition you should know about (so you can have his back if nothing else); maybe try a casual "By the way, I put your Shmenlerzepton back in the cabinet for you" and see if he takes it from there.

Hi there, thanks everyone and thanks Sars! As it happens, really shortly after I wrote the letter, my boyfriend "came out" to me on his own. I guess he also sensed that it was time. He does take the medication as an antidepressant and, as I stated, it's not a big deal to me (although I guess it did freak me enough to write in; I should probably mention that someone else that I was interested in, year ago, told me that we could not be together because I was not capable of being a partner to someone with depression. I hope they were wrong/I've grown since then…)

He'd fibbed for the reasons you all suggested – he was worried that I'd freak, judgment is common especially in dating, and it's hard to know when to reneg on a not-quite-true premise once you grow closer to someone. I think some fiction has been written about that situation. I'm glad he felt comfortable telling me and that I didn't bring it up, but let him talk about it when he was ready. Your advice was spot on.

I'm a pharmaceutical chemist, which is not the same as a pharmacologist, but you're pretty much right on. The problem with off label use is that it's exactly that, off label. There's no official clinical trial, so the information is based on side effects noted in the clinical trials and anecdotal evidence from doctors. So sometimes off label uses are pretty well understood and widely known, and other times it's a lot more, shall we say, subjective.

Which is a complete sidebar relative to your original question, but there you are.

My experience with an ex on anti-depressants was a bit different: after we were past the first few dates and started spending time at each other's apartments, he was totally up-front about it. His rationale for telling me was that he was on them for real reasons that weren't affecting the relationship, and I wasn't judgy about mental illness, but like many anti-depressants, the meds did have a sexual side effect, and he wanted me to be prepared for that. I think it was the right thing to do, since it would have been more traumatic for both of us to have that first conversation in bed when things didn't quite work as expected.

Realistically, if it affects you or your relationship with him, it is your business, but it's his brain & body; if he has to be guilted or coerced into admitting something he's not ready to admit, he'll resent you for it. I think you handled it well by not making it A Thing and just being matter-of-fact about it, and he probably appreciated the trust in him that approach represents.

I would bring it up now, but I am not patient enough to wait for the bf to bring up the topic.

As someone who will probably be on anti-depressants for life, I think it's very important that he tell you about why he takes the medication. Significant others deserve to know about major medical conditions. It's something that needs to be discussed by the time a long-term commitment is in the works. Even a well-managed chronic condition affects a person, and it's dishonest not to share that info with a serious partner.

Since you saw the bottle, I would ask, and use the response as I would anything else I learned from dating the guy.

Not that it's relevant, I used to have to take an anti-depressant to try and get the nerve endings in my vagina to calm the fuck down and not be so goddanm painfully sensitive (like that thing on Sex and The City where everyone teased Charlotte for having a depressed vagina), so in my case, I probably would have lied and said I was depressed.

I support all the others to say this may be an off-label use. I have residual itching from shingles – so topical anti-itch does nothing (plus it is under my hair, so it is not like I can smear lotions on my head). When I finally got a medication to use when it is so bad I scratch my head sore, I looked it up and it is actually an anti-anxiety drug. My instructions have an "as needed for itching" instruction, but look up the med and it is for anxiety.

I would give him the chance to tell you about it, but it depends on how serious the relationship is. If you think there's a chance of marrying this guy, or even just living together, you need to be more in the loop. What if he has a medical issue and you're the one in the ER with him being asked about medications and possible side effects with whatever they're going to do? What if you decide to have children and whatever he takes the medication for is genetic? There's a point at which you have to know. I understand why he would be private about it if it really is an anti-depressant, but when the relationship starts to get serious, you need to know what's really going on with him.

You're being weird and obsessive about this issue. Why do you care if he uses an anti-depressant or acne medication? You acknowledge you're being nosy and you actually have no proof he's lying. As was pointed out, anti-depressants can treat a variety of ailments. He might not even know the medication can be used for depression.

At the worst, he's told a white lie about something he's legitimately embarrassed about. It's not trust or comfort or closeness, so don't take it that way. If he's really "lying to you," then it's because he doesn't want to discuss it. What he puts in his body is actually not really your business, not at this stage of your relationship. Sure, you could say "Hey, I saw your bottle, and this is an anti-depressant. I was right all along! Let's have a heart to heart about your emotional state." Nothing will be gained from that. In fact, he'll probably lose trust in you.

I highly doubt that this is some kind of passive way of "letting you know the truth." My advice: let it go and try to forget about it. A doctor prescribed it, he takes it faithfully, and it provides him some benefit. That's what matters. The idea that you "need to know" this information is kind of silly. Maybe if you're considering marriage, maybe. But if it's a non-life threatening thing that's resolved by medication, it's hardly need to know information.

@Nikki: I thought Justs concern was quite valid, the secret, not the medication, could have become a big problem some time. If the relationship in other ways is open and trusting, it's not "weird and obsessive" to wonder about this one thing. And the partner has nothing to be "legitimately embarrassed about", why should he be embarrassed? The reason why people keep quiet about mental problems is the judgement that sadly still is around. As for example that one should be embarrassed about it.

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